Provider Demographics
NPI:1376591784
Name:KOVACH, KENNETH S (OD)
Entity Type:Individual
Prefix:MR
First Name:KENNETH
Middle Name:S
Last Name:KOVACH
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4299 KENT RD.
Mailing Address - Street 2:SUITE #1
Mailing Address - City:STOW
Mailing Address - State:OH
Mailing Address - Zip Code:44224-4365
Mailing Address - Country:US
Mailing Address - Phone:330-688-1800
Mailing Address - Fax:330-688-1824
Practice Address - Street 1:4299 KENT RD.
Practice Address - Street 2:SUITE #1
Practice Address - City:STOW
Practice Address - State:OH
Practice Address - Zip Code:44224-4365
Practice Address - Country:US
Practice Address - Phone:330-688-1800
Practice Address - Fax:330-688-1824
Is Sole Proprietor?:No
Enumeration Date:2006-05-05
Last Update Date:2010-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH3295152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0441043Medicaid
OH0441043Medicaid
T47281Medicare UPIN